As amended 4/9/2026: - Requires a determination to downcode a claim, which is the unilateral alteration by a payer of the service or procedure code submitted on a claim resulting in a lower payment, to include a documented review of the clinical information supporting the billed service. - Establishes requirements for and limitations of downcoding decisions, and, if a claim is downcoded. - Requires a plan or insurer to provide a billing provider with specified information and a clear and accessible process for disputing downcoded claims.
| Date | Chamber | Action |
|---|---|---|
May 14, 2026 | A | Hearing Scheduled - Appropriations |
May 6, 2026 | A | Hearing Scheduled - Appropriations |
May 6, 2026 | — | In committee: Set, first hearing. Referred to APPR. suspense file. |
Apr 13, 2026 | — | Re-referred to Com. on APPR. pursuant to Assembly Rule 96. |
Apr 13, 2026 | — | Re-referred to Com. on P. & C.P. |
Apr 9, 2026 | — | Read second time and amended. |
Apr 8, 2026 | — | From committee: Amend, and do pass as amended and re-refer to Com. on P. & C.P. (Ayes 16. Noes 0.) (April 7). |
Apr 7, 2026 | A | Hearing Scheduled - Health |
| Last Action | May 6, 2026 |
|---|---|
| Year | 2025 |
| Bill Type | Bill |
| Created | Mar 21, 2026 |
| Updated | May 8, 2026 |